Risk Stratification to Decrease Unnecessary Diagnostic Imaging for Acute Appendicitis.

Abstract:

BACKGROUND:There has been an increase in the use of imaging modalities to diagnose appendicitis despite evidence that can help identify children at especially high or low risk of appendicitis who may not benefit. We hypothesized that the passive diffusion of a standardized care pathway (including diagnostic imaging recommendations) would improve the diagnostic workup of appendicitis by safely decreasing the use of unnecessary imaging when compared with historical controls and that an electronic, real-time decision support tool would decrease unnecessary imaging. METHODS:We used an interrupted time series trial to compare proportions of patients who underwent diagnostic imaging (computed tomography [CT] and ultrasound) between 3 time periods: baseline historical controls, after passive diffusion of a diagnostic workup clinical pathway, and after introduction of an electronic medical record-embedded clinical decision support tool that provides point-of-care imaging recommendations (active intervention). RESULTS:The moderate- and high-risk groups showed lower proportions of CT in the passive and active intervention time periods compared with the historical control group. Proportions of patients undergoing ultrasound in all 3 risk groups showed an increase from the historical baseline. Time series analysis confirmed that time trends within any individual time period were not significant; thus, incidental secular trends over time did not appear to explain the decreased use of CT. CONCLUSIONS:Passive and active decision support tools minimized unnecessary CT imaging; long-term effects remain an important area of study.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Depinet H,von Allmen D,Towbin A,Hornung R,Ho M,Alessandrini E

doi

10.1542/peds.2015-4031

subject

Has Abstract

pub_date

2016-09-01 00:00:00

issue

3

eissn

0031-4005

issn

1098-4275

pii

peds.2015-4031

journal_volume

138

pub_type

临床试验,杂志文章
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    abstract::In a test of Feingold's hypothesis that food additives trigger the hyperactive response, 26 hyperactive children were randomly assigned to treatment conditions whereby they were given active or placebo medications in combination with challenge cookies with artificial food colors or control cookies without the additive...

    journal_title:Pediatrics

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

    authors: Williams JI,Cram DM,Tausig FT,Webster E

    更新日期:1978-06-01 00:00:00

  • Arkansas' experience: statewide surveillance and parental information on the child obesity epidemic.

    abstract::Parents, clinicians, public health officials, and policy makers need readily available information on the extent of the childhood obesity epidemic. As in any epidemic, the strategies and tools used to combat the imminent threat are frequently based on scientific rationale and experience but applied in areas in which w...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2008-3586J

    authors: Thompson JW,Card-Higginson P

    更新日期:2009-09-01 00:00:00

  • Recommendations for Prevention and Control of Influenza in Children, 2016-2017.

    abstract::The purpose of this statement is to update recommendations for the routine use of seasonal influenza vaccine and antiviral medications for the prevention and treatment of influenza in children. The AAP recommends annual seasonal influenza immunization for everyone 6 months and older, including children and adolescents...

    journal_title:Pediatrics

    pub_type: 杂志文章,实务指引

    doi:10.1542/peds.2016-2527

    authors: COMMITTEE ON INFECTIOUS DISEASES.

    更新日期:2016-10-01 00:00:00

  • Diagnosis and management of acute sinusitis by pediatricians.

    abstract:BACKGROUND:Acute sinusitis is frequently diagnosed in young children, yet little is known regarding pediatrician practices surrounding its diagnosis and management. OBJECTIVES:The purpose of this work was to describe how pediatricians diagnose and manage nonsevere acute sinusitis in otherwise healthy children < or =6 ...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2008-2479

    authors: McQuillan L,Crane LA,Kempe A

    更新日期:2009-02-01 00:00:00

  • Obesity risk for female victims of childhood sexual abuse: a prospective study.

    abstract:OBJECTIVE:Efforts are under way to articulate environmental, psychosocial, and biological conditions that may predispose the development and maintenance of obesity. There is increasing evidence that adverse childhood experiences such as childhood abuse may be implicated in the development of obesity. Given the dearth o...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2006-3058

    authors: Noll JG,Zeller MH,Trickett PK,Putnam FW

    更新日期:2007-07-01 00:00:00

  • Successive multisite peripheral nerve catheters for treatment of complex regional pain syndrome type I.

    abstract::Complex regional pain syndrome (CRPS) type I is a painful and disabling syndrome that is accompanied by physical changes in the affected extremity. It generally occurs after trauma, manifesting as pain that is out of proportion to the inciting event. Treatment of the disorder is difficult, with many patients being ref...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2011-3779

    authors: Martin DP,Bhalla T,Rehman S,Tobias JD

    更新日期:2013-01-01 00:00:00

  • Annual summary of vital statistics--1980.

    abstract::Data for this article, as in previous reports, are drawn principally from the Monthly Vital Statistics Report, published by the National Center for Health Statistics. The international data come from the Demographic Yearbook and the quarterly Population and Vital Statistics Report, both published by the Statistical Of...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Wegman ME

    更新日期:1981-12-01 00:00:00

  • Reducing violent injuries: priorities for pediatrician advocacy.

    abstract::A basic framework for developing an advocacy plan must systematically break down the large task of policy development implementation into manageable components. The basic framework described in detail in this paper includes three steps: Setting policy objectives by narrowing the scope of policy, by reviewing policy op...

    journal_title:Pediatrics

    pub_type: 杂志文章,评审

    doi:

    authors: Dolins JC,Christoffel KK

    更新日期:1994-10-01 00:00:00

  • Otitis media in developing countries.

    abstract:OBJECTIVE:This article reviews the available information concerning the disease burden, epidemiology, and etiology of otitis media in developing countries and the likelihood that case management with appropriate antibiotic therapy can reduce the burden of this disease. METHODOLOGY:The available literature was reviewed...

    journal_title:Pediatrics

    pub_type: 杂志文章,评审

    doi:

    authors: Berman S

    更新日期:1995-07-01 00:00:00

  • Occult spinal dysraphism: a series of 73 cases.

    abstract::The subject of occult spinal dysraphism or myelodysplasia is reviewed from standpoints of embryology, clinical manifestations, and treatment, and the management of 73 cases summarized. In general, these concealed lesions arise from developmental variants in the most distal part of the neural tube, a situation which ma...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Anderson FM

    更新日期:1975-06-01 00:00:00

  • Successful use of plasma exchange for profound hemolysis in a child with loxoscelism.

    abstract::We describe a 6-year-old boy who presented with massive hemolysis, shock, disseminated intravascular coagulopathy, and acute renal failure after loxosceles envenomation. In this patient, plasma exchange therapy (PEX) successfully cleared the plasma from an initial hemolytic index of 2000 (equivalent to 2 g/dL hemoglob...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2013-3338

    authors: Said A,Hmiel P,Goldsmith M,Dietzen D,Hartman ME

    更新日期:2014-11-01 00:00:00

  • Erythema Marginatum as an Early Symptom of Hereditary Angioedema: Case Report of 2 Newborns.

    abstract::Hereditary angioedema due to C1 inhibitor deficiency (C1-INH-HAE) is a rare genetic disease that causes recurrent swelling attacks that may affect various body tissues. Angioedematous attacks can be fatal in the case of upper airway edema and are often preceded by prodromal symptoms like erythema marginatum. Initial s...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2015-2411

    authors: Martinez-Saguer I,Farkas H

    更新日期:2016-02-01 00:00:00

  • Gypsies and acute medical intervention.

    abstract::Recently, a 7-month-old, terminally ill Gypsy infant was admitted to a pediatric intensive care unit. Treating this child and her extended family was a challenging experience during which numerous culture-related problems were encountered. The Gypsy approach to acute medical care consisted of the presence of a large e...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Wetzel RC,Dean JM,Rogers MC

    更新日期:1983-11-01 00:00:00

  • Prediction of death for extremely low birth weight neonates.

    abstract:OBJECTIVE:To compare multiple logistic regression and neural network models in predicting death for extremely low birth weight neonates at 5 time points with cumulative data sets, as follows: scenario A, limited prenatal data; scenario B, scenario A plus additional prenatal data; scenario C, scenario B plus data from t...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2004-2099

    authors: Ambalavanan N,Carlo WA,Bobashev G,Mathias E,Liu B,Poole K,Fanaroff AA,Stoll BJ,Ehrenkranz R,Wright LL,National Institute of Child Health and Human Development Neonatal Research Network.

    更新日期:2005-12-01 00:00:00

  • Helping Children and Families Deal With Divorce and Separation.

    abstract::For the past several years in the United States, there have been more than 800 000 divorces and parent separations annually, with over 1 million children affected. Children and their parents can experience emotional trauma before, during, and after a separation or divorce. Pediatricians can be aware of their patients'...

    journal_title:Pediatrics

    pub_type: 杂志文章,评审

    doi:10.1542/peds.2016-3020

    authors: Cohen GJ,Weitzman CC,COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH.,SECTION ON DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS.

    更新日期:2016-12-01 00:00:00

  • A 17-Year-Old With Chest Pain.

    abstract::A 17-year-old male subject with a history of deep venous thrombosis presented with acute unilateral severe chest pain. His examination was nonspecific, and vital signs were normal. His initial laboratory evaluation revealed mild thrombocytopenia, elevated troponin levels, and critically elevated activated partial thro...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2016-0794

    authors: Shah AY,Jamison M,Otero HJ,Jung L,Frank LH,Guerrera MF,Kirkorian AY

    更新日期:2017-03-01 00:00:00

  • Maternal and infant factors associated with failure to thrive in children with vertically transmitted human immunodeficiency virus-1 infection: the prospective, P2C2 human immunodeficiency virus multicenter study.

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    journal_title:Pediatrics

    pub_type: 杂志文章,多中心研究

    doi:10.1542/peds.108.6.1287

    authors: Miller TL,Easley KA,Zhang W,Orav EJ,Bier DM,Luder E,Ting A,Shearer WT,Vargas JH,Lipshultz SE,Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection (P2C2 HIV) Study Group.,National Heart, Lung,

    更新日期:2001-12-01 00:00:00

  • The adverse effect of negative comments about weight and shape from family and siblings on women at high risk for eating disorders.

    abstract:OBJECTIVE:Our purpose with this work was to examine the relationship between negative comments about weight, shape, and eating and social adjustment, social support, self-esteem, and perceived childhood abuse and neglect. METHODS:A retrospective study was conducted with 455 college women with high weight and shape con...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2005-1806

    authors: Taylor CB,Bryson S,Celio Doyle AA,Luce KH,Cunning D,Abascal LB,Rockwell R,Field AE,Striegel-Moore R,Winzelberg AJ,Wilfley DE

    更新日期:2006-08-01 00:00:00

  • Dyssomnias and parasomnias in early childhood.

    abstract:OBJECTIVES:Our aim for this study was to determine the prevalence of dyssomnias and various parasomnias in early childhood and to describe their temporal evolution, gender differences, and correlates. METHODS:This research is part of a longitudinal study of child development. A randomized, 3-level, stratified survey d...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2006-2132

    authors: Petit D,Touchette E,Tremblay RE,Boivin M,Montplaisir J

    更新日期:2007-05-01 00:00:00

  • Lupus nephritis: prognostic factors in children.

    abstract::As newer treatment modalities become available for patients with severe lupus nephritis, it becomes increasingly important to identify patients at risk for renal failure. In this study, the records of 90 children presenting with systemic lupus erythematosus over a 13-year period were reviewed. Nineteen were lost to fo...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: McCurdy DK,Lehman TJ,Bernstein B,Hanson V,King KK,Nadorra R,Landing BH

    更新日期:1992-02-01 00:00:00

  • Early Intervention, Parent Talk, and Pragmatic Language in Children With Hearing Loss.

    abstract:BACKGROUND AND OBJECTIVES:Pragmatic language skills form the foundation for conversational competence, whereas deficits in this area are associated with behavioral problems and low literacy skills. Children who are deaf or hard of hearing demonstrate significant delays in this critical area of language. Our purpose wit...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2020-0242F

    authors: Yoshinaga-Itano C,Sedey AL,Mason CA,Wiggin M,Chung W

    更新日期:2020-11-01 00:00:00

  • Change in prevalence of congenital defects in children with Prader-Willi syndrome.

    abstract:OBJECTIVE:The aim of this study was to assess the prevalence of congenital defects observed in patients with Prader-Willi syndrome (PWS) and to compare this prevalence with that described in the general population. In addition, these findings were correlated with the different etiologic subtypes. METHODS:A total of 18...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2012-1103

    authors: Torrado M,Foncuberta ME,Perez MF,Gravina LP,Araoz HV,Baialardo E,Chertkoff LP

    更新日期:2013-02-01 00:00:00

  • Costs and Use for Children With Medical Complexity in a Care Management Program.

    abstract:BACKGROUND AND OBJECTIVES:Children with medical complexity (CMC) comprise only 6% of the pediatric population, account for ∼40% of pediatric health care spending, and provide an important opportunity for cost saving. Savings in this group can have an important impact on pediatric health care costs. The objective of thi...

    journal_title:Pediatrics

    pub_type: 杂志文章,多中心研究

    doi:10.1542/peds.2019-2401

    authors: Bergman DA,Keller D,Kuo DZ,Lerner C,Mansour M,Stille C,Richardson T,Rodean J,Hudak M

    更新日期:2020-04-01 00:00:00

  • Using mass media to reduce adolescent involvement in drug trafficking.

    abstract:OBJECTIVE:Drug trafficking among adolescents is a newly recognized high-risk behavior that seems to be involving large numbers of youths. Strategies to prevent and/or alter this behavior must be developed and evaluated. In view of the high exposure of adolescents to the mass media, interventionists seeking to reduce ad...

    journal_title:Pediatrics

    pub_type: 杂志文章,评审

    doi:

    authors: Romer D

    更新日期:1994-06-01 00:00:00

  • Sexuality, contraception, and the media. Committee on Public Education.

    abstract::Early sexual intercourse among American adolescents represents a major public health problem. Although early sexual activity may be caused by a variety of factors, the media are believed to play a significant role. In film, television, and music, sexual messages are becoming more explicit in dialogue, lyrics, and beha...

    journal_title:Pediatrics

    pub_type: 指南,杂志文章

    doi:10.1542/peds.107.1.191

    authors: American Academy of Pediatrics. Committee on Public Education, American Academy of Child and Adolescent psychiatry, American Psychological Association.

    更新日期:2001-01-01 00:00:00

  • Stunting of growth as a major feature of anorexia nervosa in male adolescents.

    abstract:OBJECTIVE:To assess growth retardation in male adolescent patients who have a diagnosis of anorexia nervosa (AN) and the effect of weight restoration on catch-up growth. METHODS:Medical charts of all male adolescent AN patients (n = 12) who were admitted to the Pediatric Psychosomatic Department at the Sheba Medical C...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.111.2.270

    authors: Modan-Moses D,Yaroslavsky A,Novikov I,Segev S,Toledano A,Miterany E,Stein D

    更新日期:2003-02-01 00:00:00

  • A residential summer camp for children with vertically transmitted HIV/AIDS: a six-year experience at the Hole in the Wall Gang Camp.

    abstract::Residential camping sessions for children with vertically transmitted human immunodeficiency virus/acquired immunodeficiency syndrome have been offered at The Hole In The Wall Gang Camp for the past six summers. More than 600 children 6 to 12 years of age have attended. Such sessions are expensive and require extensiv...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.100.4.709

    authors: Pearson HA,Johnson S,Simpson BJ,Gallagher M

    更新日期:1997-10-01 00:00:00

  • Heelys and street gliders injuries: a new type of pediatric injury.

    abstract:OBJECTIVES:Our goals were to highlight an increasing trend in orthopedic injuries in children as a result of "heeling" or "street gliding," to describe injuries sustained by children using Heelys (HSL, Carrollton, TX) and Street Gliders (Glowgadgets Ltd, Bristol, United Kingdom), and to increase public awareness and pr...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2006-2882

    authors: Vioreanu M,Sheehan E,Glynn A,Casidy N,Stephens M,McCormack D

    更新日期:2007-06-01 00:00:00

  • Etiologies of NICU deaths.

    abstract:BACKGROUND AND OBJECTIVES:Infant mortality is an indicator of overall societal health, and a significant proportion of infant deaths occur in NICUs. The objectives were to identify causes of death and to define potentially preventable factors associated with death as areas for quality improvement efforts in the NICU. ...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2014-2967

    authors: Jacob J,Kamitsuka M,Clark RH,Kelleher AS,Spitzer AR

    更新日期:2015-01-01 00:00:00

  • Pulmonary vein stenosis: prematurity and associated conditions.

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2008-0075

    authors: Drossner DM,Kim DW,Maher KO,Mahle WT

    更新日期:2008-09-01 00:00:00